Blood Transfusion-Associated Necrotizing Enterocolitis in Neonates

Abstract

Aim: This review aims to analyze literature to find the association between blood transfusion and necrotizing enterocolitis in premature neonates. Objectives: 1. To evaluate which factors, influence the development of necrotizing enterocolitis (NEC) in neonates. 2. To analyze whether feeding before blood transfusion has any effect on the development of NEC in neonates. 3. To evaluate the association between severe anemia and NEC in neonates. Methodology: The study was performed according to the PRISMA guidelines between February 2, 2023, and October 11, 2023. Relevant research was gathered from the PubMed database, and a primary search was then conducted using the keywords “Necrotizing enterocolitis” or “NEC” AND “Blood transfusion in neonates” or “in preterm baby” or “in prematurity”. Subsequently, filters such as English language and publication within the last 10 years were applied, and the remaining articles underwent manual screening based on the inclusion and exclusion criteria, resulting in the inclusion of 10 articles in the research. Results: 10 articles were reviewed, that consisted mostly of retrospective studies – either cohort or case-control. Two of the studies either case-control study or prospective single-center randomized controlled studies. The reviewed articles represented 3,859 patients. The studies evaluated the association between NEC, feeding, and blood transfusion by analyzing different feeding regimens. Other studies assessed factors influencing the development of NEC, particularly its association with blood transfusion and anemia. Conclusions: 1. The development of NEC in premature infants is influenced by factors such as low gestational age and birth weight, which contribute to the vulnerability of their underdeveloped gastrointestinal tracts. Furthermore, the role of blood transfusion in NEC development remains debated. Some studies suggest a significant correlation after day of life 14, while others do not find such a connection. 2. Some research suggests that withholding feeding during a blood transfusion decreases the risk of NEC and transfusion-associated necrotizing enterocolitis (TANEC), while others disagree. The introduction of the standardized slow enteral feeding (SSEF) protocol has shown promising results, but further studies are needed to fully understand its effectiveness in reducing the incidence of NEC and TANEC. 3. Severe anemia poses a risk of developing NEC in very low birth weight infants; therefore, early prevention and treatment of anemia may decrease the rate of NEC. However, uncertainty remains regarding whether anemia independently contributes to the risk of NEC, as infants with NEC diagnosis often have concurrent anemia.